WIDE PERINEAL DISSECTION AND ITS EFFECT ON LOCAL RECURRENCE FOLLOWINGPOTENTIALLY CURATIVE ABDOMINOPERINEAL RESECTION FOR RECTAL ADENOCARCINOMA

Ninety-three patients underwent a potentially curative abdominoperinea l resection (APR) with a wide perineal dissection to the ischial tuber osities and excision of the entire mesorectum. There were 56 males and 37 females. The median follow-up was 67 months (range 7-240 months). The lymph node clearing technique was used and the median number of ly mph nodes cleared was 35 (range 6-89). Eighteen of 93 patients (19%) d eveloped a local recurrence, 12 of whom (13%) developed local recurren ce only as the first site of recurrence. In 10 of 18 patients (56%) th e distal rectum was the site of the primary rectal cancer. Of the 18 p atients, I patient had stage I disease, 5 stage II, and 12 stage III. Five of the 18 patients (28%) who developed a local recurrence receive d adjuvant therapy. The median survival from the time of diagnosis of a local recurrence was 12 months. Histological grade (p =.001), patien t age (p =.006), and presence of positive lymph nodes (p =.005) had a statistically significant adverse effect on survival. We believe the s urgical technique of abdominoperineal resection with wide perineal res ection to the ischial tuberosities and total excision of the mesorectu m allowed us to achieve a low local recurrence rate (13%) in a high-ri sk group of patients. Clearly, the best form of prevention for local r ecurrence from rectal adenocarcinoma is radical surgical therapy of th e primary tumor.